- Humana (Albany, NY)
- …internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to ... include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope. The… more
- Molina Healthcare (Albany, NY)
- …medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse ... medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred… more
- FlexStaff (Chappaqua, NY)
- …of 2 years of experience in medical billing, including filing claim appeals . The ideal candidate will have strong organizational skills, excellent attention to ... MUST HAVE Medical Billing & AR Experience- Experience in Medicare Part B and in Network Managed Care, Medical...accuracy based on fee schedules - Prepare and submit appeals for underpaid or denied claims - Follow up… more
- J&J Family of Companies (Smithtown, NY)
- …assigned. . Educate HCPs on product coverage, prior authorizations and appeals , reimbursement processes, claims submissions, procedures, and coding requirements of ... access and affordability solutions across multiple payer types and plans (ie, Medicare , Medicaid Managed Care, Commercial). . Execute business in accordance with the… more
- J&J Family of Companies (New York, NY)
- …assigned. + Educate HCPs on product coverage, prior authorizations and appeals , reimbursement processes, claims submissions, procedures, and coding requirements of ... access and affordability solutions across multiple payer types and plans (ie, Medicare , Medicaid Managed Care, Commercial). + Execute business in accordance with the… more
- J&J Family of Companies (Newburgh, NY)
- …assigned. + Educate HCPs on product coverage, prior authorizations and appeals , reimbursement processes, claims submissions, procedures, and coding requirements of ... access and affordability solutions across multiple payer types and plans (ie, Medicare , Medicaid Managed Care, Commercial). + Execute business in accordance with the… more
- Stony Brook University (East Setauket, NY)
- …business functions including, but not limited to: billing, claims analysis appeals , follow-up, financial assistance and customer service. **Duties of a Revenue ... on rejected or denied claims, improper payments and coding issues. + Process appeals . + Liaise with third party billing and collection agencies. + Identify issues… more
- Stony Brook University (East Setauket, NY)
- …business functions including but not limited to: billing, claims analysis appeals , follow-up, financial assistance and customer service. **Duties of a Revenue ... on rejected or denied claims, improper payments and coding issues. + Process appeals . + Liaise with third party billing and collection agencies. + Identify issues… more
- New York State Civil Service (Queens Village, NY)
- …assist in contacting insurance company for preauthorization payments, and/or file appeals on denials of preauthorization. * Participating in the formulation, ... eligibility for full and unconditional participation in the Medicaid and Medicare programs. Failure to maintain certification and Medicaid/ Medicare eligibility… more
- Humana (Albany, NY)
- …includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age). + Current and ongoing Board ... **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical… more